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Can pelvic incidence change after spinal deformity correction to the pelvis with S2-alar-iliac screws?

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Abstract

Purpose

Pelvic incidence (PI) is assumed to be fixed, yet studies have reported PI changes after long fusions to the pelvis. In a cohort of ASD patients undergoing surgery with S2-alar-iliac (S2AI) screws, we sought to: (1) report the magnitude of PI changes, and (2) evaluate subsequent pelvic parameter changes.

Methods

A retrospective case series of ASD patients undergoing surgical correction with S2AI screw placement and sagittal cantilever correction maneuvers was conducted. Patients were categorized based on preoperative PI: High-PI (H-PI) (PI ≥ 60°); Normal-PI (N-PI) (60° > PI > 40°); Low-PI (L-PI) (PI ≤ 40°). PI was measured preoperatively and immediately postoperatively. A significant PI change was established a priori at ≥ 6.0. PI, pelvic tilt (PT), lumbar lordosis (LL), and PI-LL mismatch were analyzed.

Results

In 68 patients (82.3% female, ages 22–75 years), the average change in PI was 4.6° ± 3.1, and 25 (36.8%) had a PI change ≥ 6.0° with breakdown as follows: H-PI 12 (66.7%) patients, 9 (25.87%) patients, and 4 (33.3%) patients. Of 25 patients with PI changes, 10 (14.7%) had a PI increase and 15 (22.1%) had a PI decrease. Significant improvements were seen in PT, LL, PI-LL mismatch in all patients with a PI change ≥ 6.0°, in addition to both subgroups with an increase or decrease in PI.

Conclusions

PI changes of ≥ 6.0° occurred in 36.8% of patients, and H-PI patients most commonly experienced PI changes. Despite PI alterations, pelvic parameters significantly improved postoperatively. These results may be explained by sacroiliac joint laxity, S2AI screw placement, or aggressive sagittal cantilever techniques.

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Funding

No funding was used to support the current research.

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Authors and Affiliations

  1. Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China

    Chao Wei

  2. Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital At New York Presbyterian, New York, NY, USA

    Scott L. Zuckerman, Meghan Cerpa & Lawrence G. Lenke

  3. Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China

    Hong Ma

  4. Department of Spine Surgery, Xi’an Honghui Hospital, Xi’an Jiaotong University, Xi’an, China

    Ming Yang & Suomao Yuan

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  1. Chao Wei
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  2. Scott L. Zuckerman
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  3. Meghan Cerpa
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  4. Hong Ma
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Correspondence to Scott L. Zuckerman.

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Wei, C., Zuckerman, S.L., Cerpa, M. et al. Can pelvic incidence change after spinal deformity correction to the pelvis with S2-alar-iliac screws?. Eur Spine J 30, 2486–2494 (2021). https://doi.org/10.1007/s00586-020-06658-3

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